Your Digest for Sunday, Mar 31, 2024 03:59 PM


[!TIP] Mnemonic:
LPFB - P looks like R -> Right axis deviation
LAFB - LA - Left Axis Deviation
LBBB - also left axis deviation
LeftPosteriorFascicularBlockMnemonicRAD.png


| Causes Left Axis Deviation | No effect on axis |
| Affects MI diagnosis | No effect on MI diagnosis|
| Best seen in V6 - M pattern| Best see in V1 - RSR pattern|
the 'best seen' lead views the heart from the same side as the blocked bundle.

[!INFO] Shortcut to diagnosing BBBs
Another simple way to diagnose a left bundle branch in an ECG with a widened QRS complex (> 120 ms) would be to look at lead V1.

[!INFO] ECG criteria for LBBB:

  1. QRS duration greater than 120 milliseconds
  2. Absence of Q wave in leads I, V5 and V6
  3. Monomorphic R wave in I, V5 and V6
  4. ST and T wave displacement opposite to the major deflection of the QRS complex
    Source

Neurologic:


The classic finding is subacute combined dengeneration (SACD) of the spinal cord.

[!INFO] What is 'combined'?

Signs



Thiazide diuretics bind to the chloride receptor of the Na-Cl cotransporter in the DCT and inhibit it's function causing urinary loss of Sodium and Chloride.


[!TIP] Mnemonic: TET
Like a "TET" spell
Triptans, erogatamine, Telcagepant
Acute -> Agonist (fewer letters, quicker to say)
- Verapamil - can cause headache on it's own but reduced migraine frequency.
- Cyproheptadine - 5HT2 receptor antagonist; also has antihistamine activity.


Anatomy of the CNIII nucleus

Cranial nerves in intracranial hypertension

The cranial nerves most commonly affected by intracranial pressure are the

  1. Abucent nerve (VI) - lateral rectus palsy
  2. Trochlear nerve (IV) - palsy of superior oblique
  3. Oculomotor nerve (III) - 'Down and out' pupil.
    Source

Mechanisms:

Abducens nerve

Causes of abducens nerve palsy:
Source
Source

abducensNerveCranialNerveVIfacialNerve.png

Source
Source
OneAndAHalfOAHSyndrome.jpg

Trochlear nerve



Carey coombs - Coombs for carditis



AntianginalMedicationsSketch.png
1. All patients should be on aspirin and statin.

ACEi can be used to prevent ACS in aginal patients. Source


1. **Primary idiopathic**
2. **Primary immune complex mediated** - eg. Goodpasture's syndrome (Goodpasture's has less recurrence than GPA - PasTest answers); From the image above, *these are small vessel vasculitidies*. 
    5. Cryoglobulinaemic vasculitis (CryoVas)
    6. ?Behcet' disease
    7. 
  1. Secondary

[!INFO] The distinction between GCA and Takayasu is made mainly base on patients age!
Because histologically, they are very similar.

[!INFO] Diagnosis:
ESR and biopsy are very suggestive for PMR but both can be falsely negative!

- One of which is the **temporal artery**. 
- Other arteries: *ophthalmic*, *occipital*, **vertebral**, *posterior ciliary*
- Can also cause *mononeuritis mulitplex*. [Source](https://emedicine.medscape.com/article/316024-overview#showall)
- *However*, *ESR can be normal* in upto 20%; Therefore, normal ESR doesn't exclude GCA. 

Treatment: Corticosteroids +/- azathioprine.



homogentisicMnemonic.png

gentisic -> gentleman -> black suit